Health Care Politics Thread

Despite what you may think, I don't support the concept of a theocracy either; I believe in balance with all aspects working together. Idealistic?? Yes, but without some ideals, what do we have????

Originally Posted by Corwin
Now I'll put on my asbestos suit. The base issue in the US comes out of your policy of separation of Church and State!! 'Church', however you define it, for whichever religion or cult is, historically the basis of morality, giving, care, and originally, education. When you cut that out of the decision making process (gov't) and marginalise it in many people's lives, you can expect to have major issues.

Then why aren't Sweden having these issues? Nowhere else is morality so separated from religion as in Sweden.

Übereil

Here, Germany, is the absolute DREAM of any pharmaceutical company : he prices are the highest ones in europe - or perhaps even throughout the world - because the companies can set the prices like they want to. No-one's controlling them. Which has led to incredibly high "moon prices", as we call them here.

Why I hate the whole medical care thing, part 906…

After months and months of wrangling with my "insurance" company they finally agree to start paying for things. They kept sending us these forms requiring us to verify that my wife and kids didn't have some other coverage. Why would I spend extra for them to be covered under my policy if she had her own insurance? And even if I lied when I signed up why wouldn't I just lie again? And after us sending in multiples before why did they keep on sending us more? This was a total waste of time on our part and money on theirs. Grrr.

Then on Wednesday last week the medical group where we go calls and tells us we owe them almost $4000. Huh? I missed the call (I was at work) and I couldn't make out their call back number but on Friday I was in their neighborhood so I stopped by. The nice lady at the desk said we owed $120. What about the $4000? She had no idea. So I paid and while I was there I signed up for their on line service so I didn't have to rely on mailed statements to figure out what was going on.

So tonight I signed on to check up on every and see that I still owe $26. Why? I have no clue with all the payments we made earlier and payments made by the insurance company and deductions and credits for various things. The charges make no sense; one was for -$8. I should have done that a bunch more times!

Originally Posted by BillSeurer
Why I hate the whole medical care thing, part 906…

After months and months of wrangling with my "insurance" company they finally agree to start paying for things. They kept sending us these forms requiring us to verify that my wife and kids didn't have some other coverage. Why would I spend extra for them to be covered under my policy if she had her own insurance? And even if I lied when I signed up why wouldn't I just lie again? And after us sending in multiples before why did they keep on sending us more? This was a total waste of time on our part and money on theirs. Grrr.

Then on Wednesday last week the medical group where we go calls and tells us we owe them almost $4000. Huh? I missed the call (I was at work) and I couldn't make out their call back number but on Friday I was in their neighborhood so I stopped by. The nice lady at the desk said we owed $120. What about the $4000? She had no idea. So I paid and while I was there I signed up for their on line service so I didn't have to rely on mailed statements to figure out what was going on.

So tonight I signed on to check up on every and see that I still owe $26. Why? I have no clue with all the payments we made earlier and payments made by the insurance company and deductions and credits for various things. The charges make no sense; one was for -$8. I should have done that a bunch more times!

Totally not wasteful, bureaucratic, or Byzantine!

Thread necro, but this is clearly the right place for this little tidbit:
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A recent "Investor's Business Daily" article provided very interesting statistics from a survey by the United Nations International Health Organization.

Percentage of men and women who survived a cancer five years after diagnosis:

U.S. 65%
England 46%
Canada 42%

Percentage of patients diagnosed with diabetes who received treatment within six months:

U.S. 93%
England 15%
Canada 43%

Percentage of seniors needing hip replacement who received it within six months:

U.S. 90%
England 15%
Canada 43%

Percentage referred to a medical specialist who see one within one month:

U.S. 77%
England 40%
Canada 43%

Number of MRI scanners (a prime diagnostic tool) per million people:

U.S. 71
England 14
Canada 18

And now for the last statistic:

National Health Insurance?

U.S. NO
England YES
Canada YES

Interesting statistics. DTE, I'm surprised you would post anything produced by the UN? I thought you didn't think they did anything right?

I'd like to see the source for those numbers!

Not a fan of the UN by any stretch, but it does put a dent in the "biased source" gambit to grab a source near and dear to the other side. It's a chain-email excerpt, so I'll have to do a little digging to verify it. Really, the whole "fact check" thing should go before the "post" thing, but I'm a bit pressed for time and sometimes it's fun to fart in the elevator as you're getting off.

Just curious about the assumptions, but I won't hold my breath, I'll just exit, too.

Nope, it's garbage. UN International Health Organization doesn't even exist. Chain email fail, pre-post fact check fail. And there was much sadness.

EDIT: OOPS! It took some time for me writing this. so I didn't see the post above befor posting what I did. Sorry. You may safely ignore the following longish rant (which I don't bother to delete)

Not taking part in a what's best discussion, but I have 3 comments (to some degree based on my education)

1. I find it very hard to believe there's that huge difference in cancer survival between countries of similar social and economic status. I just checked the overall 5 year survival rate in Norway, it's now 65%.

I've tried to find similar data for the UK, but haven't found any general data. I found this article on a www.dailymail.co.uk about US vs UK breast cancer survival rates, which claims a huge difference between 5 year survival rates in US (85%) and the UK (74%). The data given for the UK iin the article is lower than what we find on info.cancerresearchuk.org, which lists 5 year survival rate after the year 2000 at 83%. For cancers detected in 1996-1999 survival rate was around 77%. I don't know what period the US results come from, but the UK results are definitely too low.

Like many cancers (not all) prognosis for breast cancer have improved steadily during the last 30 years, it's therefore very important to compare comparable periods. And while we're at it: How are national results calculated, especially: how many of the cancer patients are included? In Norway almost every patient with cancer is reported to a national database, which allows for (not necessarily guarantees) reasonably accurate statistics. If there are national differences here, national statistics will be biased. I don't know if these issues are relevant, but I certainly would like to know.

One more interesting thing is that the daily mail newsbit reports a 5 year survival rate in very early cancers of 97% in the us vs 77% in the UK. The UK results are too low, given the (probably more) correct overall survival rate cited above, but still there seems to be a difference. Now, according to the article in the US routine breast scanning starts at the age of 40, while in Britain the onset is at 50, and scans are performed every year/every second year in the US, every third year in UK. The article doesn't say how many of the women actually show up and get their scans, which would be interesting to know. But. As I (I think) mentioned in the rather longish article about diagnosing in the things you don't need to know, thread, there is reason to believe that around 30% of women diagnosed with very early cancers from breast scans have only temporary changes in their breasts. Unfortunately we really can't know who is who here, but survival data from early cancers will be higher where breast scans are performed earlier and more often because more women that really didn't need treatment are included. I can't say that all the difference is caused by this, but some of it will be.

What? You didn't read that post?

OK, yet another longish rant, but what I wanted to illustrate that there are a lot of variables to account for when comparing survival data between nations. There are other factors than the ones I mentioned, but I'll stop here.

2. Percentage of seniors needing hip replacement who received it within six months
How is "needing hip replacement" determined? Quite a number of factors may affect this decision, but since the nationale vs private health insurance is a subject, are us-patients without insurance who cannot afford surgery included?

One example which illustrates this: When I finished med. school in 1980, by-pass operations for angina were becoming routine. But there were long queues. We had fairly strict criteria for determining who could benefit from surgery. It was not for patients who responeded (fairly) well to conventional therapy, it was not for people above the age of 70 (higher risk of surgery), and not for those who hadn't quit smoking (because the new arteries would soon be obstructed). 20 years later, the capactity had increased significantly, but - surprise, surprise - there were still queues. Well, we didn't put as much faith in conventional treatment as we did, we no longer excluded the elderly, and we also found that smokers could benefit from surgery. All in all we had significantly relaxed our criteria for including patients in those who needed surgery. The need adapted to the capacity.

Which leads us to:

3. The number of MRIs.
Here in Norway the number of MRI's have increased tremendously during the last 15 years. When I started working as a resident in radiology (1998), we had 2 machines in a region counting 450 000 people. Now there are at least 10 (I've lost count). At the same time we have started using MRI for many conditions where we didn't consider it before. For a large part this is rational. Replacing CT scans with MRI, where MRI produce just as useful images, makes sense since CT scans are high radiation dose exams, MRI is not. Additionally, better equipment, better protocols have extended the number of examinations for which MRI is an approvement.

At the same time, doctors these days rely far less on their clinical skills than they did when I was a young doctor, which means that we peform many, many very unneccessary examinations, and the gains are therefore marginal, and at a very high cost.

A very rough (hopefully somewhat educated) guess from me is that around 30 MRIs/million make sense, more than that is overkill.

dr, who? Yes, pibbur who.

@DTE

I told those people to stop emailing me and put them on my spam list. :O